How does blood flow through the heart?

Blood flows through your heart and lungs in four steps:

1. The right atrium receives oxygen-poor blood from the body It receives blood from the superior
vena cava and inferior vena cava. and pumps it to the right ventricle through the tricuspid valve.
2. The right ventricle pumps the oxygen-poor blood to the lungs through the pulmonary valve.
3. The left atrium receives oxygen-rich blood from the lungs and pumps it to the left ventricle through
the mitral valve.
4. The left ventricle pumps the oxygen-rich blood through the aortic valve out to the rest of the body.

5. What are the phases of the cardiac action potential? (Ruaya, Siase)
The cardiac action potential is caused by the movement of charged atoms (called ions)
between the inside and outside of the cell, through proteins called ion channels. It is a brief
change in voltage (membrane potential) across the cell membrane of heart cells. The cardiac
action potential differs from action potentials found in other types of electrically excitable cells,
such as nerves. Action potentials also vary within the heart; this is due to the presence of
different ion channels in different cells

Phases of the Cardiac Action Potential:

1. Phase 4 (baseline negative state / Hypopolarization)- It occurs when the cell is at rest,
in a period known as diastole. In the standard non-pacemaker cell, the voltage during
this phase is more or less constant, at roughly -90 mV. The resting membrane potential
results from the flux of ions having flowed into the cell (e.g. sodium and calcium) and the
ions having flowed out of the cell (e.g. potassium, chloride and bicarbonate) being
perfectly balanced.

2. Phase 0 (fast action potential / Depolarization)- It consists of a rapid, positive change

in voltage across the cell membrane (depolarization) lasting less than 2 ms, in
ventricular cells and 10/20 ms in sinoatrial node cells. This occurs due to a net flow of
positive charge into the cell.  This is produced predominantly by the activation of Na +

channels, which increases the membrane conductance (flow) of Na . These channels

+

are activated when an action potential arrives from a neighboring cell, through gap
junctions. When this happens, the voltage within the cell increases slightly. If this
increased voltage reaches a certain value (threshold potential; ~-70 mV) it causes the
Na channels to open. This produces a larger influx of sodium into the cell, rapidly
+

increasing the voltage further (to ~ +50 mV

3. Phase 1 (just the potassium channels open up)- This phase begins with the rapid
inactivation of the Na channels by the inner gate (inactivation gate), reducing the
+

movement of sodium into the cell. At the same time potassium channels open and close
 rapidly, allowing for a brief flow of potassium ions out of the cell, making the membrane
potential slightly more negative. This is referred to as a ‘notch’ on the action potential
waveform.

4. Phase 2 (potassium channels and calcium voltage-gated channels open up)- This
phase is also known as the "plateau" phase due to the membrane potential remaining
almost constant, as the membrane slowly begins to repolarize. This is due to the near
balance of charge moving into and out of the cell. During this phase, delayed rectifier
potassium channels allow potassium to leave the cell while L-type calcium channels
(activated by the flow of sodium during phase 0), allow the movement of calcium ions
into the cell. These calcium ions bind to and open more calcium channels (called
ryanodine receptors) located on the sarcoplasmic reticulum within the cell, allowing the
flow of calcium out of the SR. These calcium ions are responsible for the contraction of
the heart. Calcium also activates chloride channels, which allow Cl to enter the cell. The
−

movement of Ca opposes the repolarizing voltage change caused by K and Cl . As well

2+ + −

as this increased calcium concentration increases the activity of the sodium-calcium

exchanger, and the increase in sodium entering the cell increases activity of the sodium-
potassium pump. The movement of all of these ions results in the membrane potential
remaining relatively constant. This phase is responsible for the large duration of the
action potential and is important in preventing irregular heartbeat (cardiac arrhythmia).

5. Phase 3 (Rapid Repolarization)- The L-type Ca channels close, while the slow
2+

delayed rectifier K channels remain open as more potassium leak channels open. This
+

ensures a net outward positive current, corresponding to a negative change in

membrane potential, thus allowing more types of K channels to open. 
+

PULMONARY AND SYSTEMIC:

Pulmonary circulation moves blood between the heart and the lungs. It transports
deoxygenated blood to the lungs to absorb oxygen and release carbon dioxide. The oxygenated
blood then flows back to the heart. Systemic circulation moves blood between the heart and
the rest of the body.

LUB DUB / SYSTOLE AND DIASTOLE

So the first “lub” that we hear in that lub-DUB is made by the mitral and tricuspid valves closing. And they
do that because the ventricles contract to build up pressure and pump blood out of the heart. This high
pressure caused by ventricular contraction is called systole.
Now, the “DUB” sound -- and, just to be clear, I am not talking about dubstep sounds -- that’s the aortic
and pulmonary semilunar valves closing at the start of diastole. 

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE

The first number is your systolic blood pressure -- essentially the peak pressure, produced by the
contracting ventricles that push blood out to all of your tissues.
The second reading is your diastolic blood pressure, which is the pressure in your arteries when the
ventricles are relaxed.
So if your systolic blood pressure is too low, that could mean that, say, the volume of your blood is too
low -- like, maybe because you’ve lost a lot of blood, or you’re dehydrated. And if your diastolic is too
high, that could mean that your blood pressure is high, even when it’s supposed to be lower.

PACEMAKER CELLS
Pacemaker cells are what keep your heart beating at the correct rhythm, and ensure that each cardiac
muscle cell contracts in coordination with the others.

The pacemaker cells at the start of the conduction system have the leakiest membranes, and therefore
the fastest inherent rhythms, so they control the rate of the entire heart.
And those fast, leaky cells are found in the sinoatrial node, or the SA node, up in the right atria.
1. They essentially turn the whole SA node into your natural pacemaker.
After those pacemaker cells make themselves fire, they spread their electrical impulses
to cardiac muscle cells throughout the atria.
2. The impulses leap across synapse-like connections between the cells called gap junctions, and
continue down the conduction system until they reach the atrioventricular node, or AV
node, located just above the tricuspid valve.
3. Now, when the signal hits the AV node, it actually gets delayed for like, a tenth of
a second -- so the atria can finish contracting before the ventricles contract.
4. So from the AV node, the signal travels straight down to the inferior end of the heart and
gets distributed to both sides.
5. The path the electrical impulse takes to the bottom of the heart is called the atrioventricular bundle,
also where it branches out to the left and right ventricles.
6. Finally, the signal disperses out into Purkinje fibers, which trigger depolarization in all
surrounding cells, causing the ventricles to contract from the bottom up like toothpaste